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Merchant v. Metropolitan Life Insurance Co.

United States District Court, N.D. Illinois, Eastern Division

September 3, 2014

MUMTAZ MERCHANT, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE CO., Defendant.

OPINION AND ORDER

JOAN H. LEFKOW, District Judge.

Plaintiff Mumtaz Merchant filed suit against the employee welfare benefit plan ("the Plan") provided by his former employer, International Business Machines Corporation ("IBM"), and its insurer, Metropolitan Life Insurance Company ("MetLife"). Merchant seeks payment of benefits under the Plan pursuant to section 502(a) of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). After Merchant voluntarily dismissed defendant IBM Long-Term Disability Plan (dkt. 3), the parties filed cross motions for summary judgment (dkts. 27, 30). For the following reasons, Merchant's motion is granted and MetLife's motion is denied.[1]

LEGAL STANDARD

Summary judgment obviates the need for a trial where there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(a). A genuine issue of material fact exists if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). To determine whether any genuine fact issue exists, the court must pierce the pleadings and assess the proof as presented in depositions, answers to interrogatories, admissions, and affidavits that are part of the record. Fed.R.Civ.P. 56(c). In doing so, the court must view the facts in the light most favorable to the non-moving party and draw all reasonable inferences in that party's favor. Scott v. Harris, 550 U.S. 372, 378, 127 S.Ct. 1769, 167 L.Ed.2d 686 (2007). When considering cross-motions for summary judgment, the court must be careful to draw reasonable inferences in the correct direction. See, e.g., Int'l Bhd. of Elec. Workers, Local 176 v. Balmoral Racing Club, Inc., 293 F.3d 402, 404 (7th Cir. 2002). The court may not weigh conflicting evidence or make credibility determinations. Omnicare, Inc. v. UnitedHealth Grp., Inc., 629 F.3d 697, 704 (7th Cir. 2011).

If a claim or defense is factually unsupported, it should be disposed of on summary judgment. Celotex Corp. v. Catrett, 477 U.S. 317, 323-24, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The party seeking summary judgment bears the initial burden of proving there is no genuine issue of material fact. Id. at 323. In response, the non-moving party cannot rest on bare pleadings alone but must designate specific material facts showing that there is a genuine issue for trial. Id. at 324; Insolia v. Philip Morris Inc., 216 F.3d 596, 598 (7th Cir. 2000).

BACKGROUND[2]

I. Merchant's Job At IBM

A. Job Duties

Merchant, a resident of Glendale Heights, Illinois, joined IBM as a configuration manager in its Dubuque, Iowa office on November 15, 2010. Merchant's line manager, Daniel Carriker, described Merchant's job responsibilities as follows:

Role: Guide and direct the success of Application scans of remote devices.
Tasks: Strictly a desk type of job. Office desk and Office chair.
No lifting involved beyond standard desk work (phone etc.) Does not require remaining at desk 100%. Short walks can be allowed[.] Approximately 10-30% time on the phone resolving problems. Objective: resolve problems related to scanning issues via laptop use. Most tasks revolve around using laptop for analysis or research.
Logging into servers[.] Monitoring Console results[.] Verifying logs[.] etc.[3]

(Administrative Record ("R.") 967.) Carriker also described the position as requiring Merchant to sit for seven to eight hours per day, stand for one to two hours, and occasionally carry up to ten pounds. ( Id. 958.) Carriker further noted that Merchant's position did not require any driving or travel, but that Merchant could not work from home and that his job could not be modified. ( Id. 957-58.)

B. Job Benefits

Merchant enrolled in IBM's disability insurance programs insured by MetLife. In particular, Merchant was a participant in IBM's 401(k) Disability Protection Program ("401(k) Program"), which allows disabled participants to continue making 401(k) contributions into their IBM Savings Plan accounts, and the IBM Long-Term Disability Plan ("the Plan"), which provides long-term disability insurance coverage. ( Id. 1151, 1344-1407.)

MetLife is the named fiduciary of the Plan and is responsible for providing "full and fair review of claim denials pursuant to Section 503 of ERISA." ( Id. 1253.) MetLife also administers claims for the Plan and 401(k) Program. ( Id. 1204, 1376.) As the Plan fiduciary, MetLife has

discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

( Id. 1253.)

To receive benefits under the 401(k) Program or the Plan, a participant must be "disabled." Both the Plan and the 401(k) Program define "disabled" the same way:

Disabled or Disability means that, due to Sickness or as a direct result accidental injury:
• You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and
• You are, during the Elimination Period and the next 12 months of Sickness or accidental injury unable to perform each of the material duties of Your Own Job; and
• You are, after such period unable to perform the duties of any gainful occupation for which You are reasonably qualified taking into account Your training, education and experience.

( Id. 1317, 1366.) To qualify for benefits, a participant must provide written evidence to the administrator that he has satisfied all conditions and requirements for benefits described. ( Id. 1319, 1368.) If a participant qualifies as disabled, the Plan pays monthly benefits at a rate of "50% of Your Predisability Earnings[.]" ( Id. 1363.) The 401(k) Program pays "1/12th of: Your Before-Tax Deferrals and/or Your Employer Matching Contributions... made to Your IBM Savings Plan account for the calendar year immediately preceding the calendar year in which you become Disabled; and which You elected to include for purposes of determining the 401(k) Disability Protection Program Benefit." ( Id. 1194.)

II. Merchant's Health Problems

A. Onset of Merchant's Pain and Benefits Claim

In August 2011, Merchant underwent a cardiac catherization and coronary angiogram. ( Id. 990.) After the procedure, Merchant had pain in his right groin, thigh, abdomen, and back. ( Id. 993.) He visited the Loyola Maywood Pain Management Clinic on August 22, 2011, and the physician who saw him ordered a CT scan, which showed no evidence of internal abdominal bleeding. ( Id. 643.)

On August 29, 2011, Merchant stopped working at IBM temporarily because of the pain. ( Id. 1026.) He returned to work on November 23, 2011, but ceased work entirely on December 9, 2011. ( Id. ) His short-term disability benefits were set to expire on February 27, 2012. ( Id. ) On January 26, 2012, he submitted a claim for long-term disability benefits and 401(k) plan protection. ( Id. 1070-81.) The form he included with his claim asked him to describe what prevented him ...


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